Respiratory System, health and medical assignment help

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I want the writer to read the attached 2 chapter slides and write a summary of both chapters combined.

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4/4/2015 Chapter 28 Care of Patients Requiring Oxygen Therapy Or Tracheostomy Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Why Do We Need Oxygen?    Essential for life and function of cells/tissues Respiratory, cardiovascular, hematologic systems work together, providing sufficient tissue perfusion to the body Oxygen therapy improves oxygenation and tissue perfusion Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2 Clinical Manifestations of Respiratory Distress       Dyspnea Nasal flaring Use of accessory muscles to breathe Pursed-lip or diaphragmatic breathing Decreased endurance Skin, mucous membrane changes (pallor, cyanosis) Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3 1 4/4/2015 Respiratory Assessment    Nose and sinuses Pharynx, trachea, larynx Lungs and thorax      Movement/symmetry/fremitus Resonance Breath sounds General appearance (muscle development) Skin and mucous membranes Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4 Oxygen Intake and Oxygen Delivery Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5 Assessment of Oxygenation  ABG analysis is best way to determine need for oxygen therapy. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6 2 4/4/2015 Oxygen Therapy  Purpose—relieves hypoxemia    Hypoxemia—low levels of oxygen in the blood Hypoxia—decreased tissue oxygenation Goal—use lowest fraction of inspired oxygen for acceptable blood oxygen level without causing harmful side effects Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7 Hazards & Complications of Oxygen Therapy   Combustion Oxygen-induced hypoventilation       Hypercarbia—retention of CO2 CO2 narcosis—loss of sensitivity to high levels of CO2 Oxygen toxicity Absorption atelectasis—new onset of crackles/decreased breath sounds Drying of mucous membranes Infection Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8 Oxygen Delivery Systems  Type used depends on:      Oxygen concentration required/achieved Importance of accuracy and control of oxygen concentration Patient comfort Importance of humidity Patient mobility Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9 3 4/4/2015 Low-Flow Oxygen Delivery Systems  Does not provide enough flow to meet total oxygen and air volume   Nasal cannula (1-6 L) Facemask • • • Simple Partial rebreather Non-rebreather Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 10 Nasal Cannula      Flow rates of 1-6 L/min O2 concentration of 24%44% (1-6 L/min) Flow rate >6 L/min does not increase O2 because anatomical dead space is full Assess patency of nostrils Assess for changes in respiratory rate and depth Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11 Simple Facemask     Delivers O2 up to 40%-60% Minimum of 5 L/min Mask fits securely over nose and mouth Monitor closely for risk of aspiration Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12 4 4/4/2015 Partial Rebreather Mask    Provides 60%-75% with flow rate of 6-11 L/min One third exhaled tidal volume with each breath Adjust flow rate to keep reservoir bag inflated Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13 Non-Rebreather Mask     Highest O2 level Can deliver FIO2 greater than 90% Used for unstable patients requiring intubation Ensure valves are patent and functional Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14 High-Flow Oxygen Delivery Systems  High-flow—can deliver 24%-100% at 8-15 L/min      Venturi mask Face tent Aerosol mask Tracheostomy collar T-piece Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15 5 4/4/2015 Venturi Mask    Adaptor located between bottom of mask and O2 sources Delivers precise O2 concentration—best device for chronic lung disease Switch to nasal cannula during mealtimes Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16 T-Piece    Delivers desired FIO2 for tracheostomy, laryngectomy, ET tubes Ensures humidification through creation of mist Mist should be seen during inspiration and expiration Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17 Noninvasive Positive-Pressure Ventilation (NPPV)  Uses positive pressure to keep alveoli open, improve gas exchange without airway intubation   BiPAP CPAP Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18 6 4/4/2015 CPAP (Cont.)    Delivers set positive airway pressure throughout each cycle of inhalation and exhalation Opens collapsed alveoli Used for atelectasis after surgery or cardiacinduced pulmonary edema; sleep apnea Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19 Transtracheal Oxygen Delivery (TTO)     Long-term delivery of O2 directly into lungs Small flexible catheter is passed into trachea through small incision Avoids irritation that nasal prongs cause; is more comfortable Flow rates prescribed for rest, activity Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 20 Home Oxygen Therapy   Criteria for equipment Patient education:    Compressed gas in tank or cylinder Liquid oxygen in reservoir Oxygen concentrator Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21 7 4/4/2015 Tracheostomy    Tracheotomy—surgical incision into trachea for purpose of establishing an airway Tracheostomy—stoma (opening) that results from tracheotomy May be temporary or permanent Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 22 Possible Complications of Tracheostomy     Pneumothorax Subcutaneous emphysema Bleeding Infection Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 23 Tracheostomy Tubes     Disposable or reusable Cuffed tube or tube without cuff for airway maintenance Inner cannula disposable or reusable Fenestrated tube Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 24 8 4/4/2015 Tracheostomy Tubes Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 25 Care Issues for the Patient with a Tracheostomy  Prevention of tissue damage:      Cuff pressure can cause mucosal ischemia Use minimal leak and occlusive techniques Check cuff pressure often Prevent tube friction and movement Prevent/treat malnutrition, hemodynamic instability, hypoxia Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 26 Causes of Hypoxia in the Tracheostomy      Ineffective oxygenation before, during, after suctioning Use of catheter that is too large for the artificial airway Prolonged suctioning time Excessive suction pressure Too frequent suctioning Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 27 9 4/4/2015 Tracheostomy Care    Assess the patient Secure tracheostomy tubes in place Prevent accidental decannulation Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 28 Air Warming and Humidification     Tracheostomy tube bypasses nose and mouth, which normally humidify, warm, and filter air Air must be humidified Maintain proper temperature Ensure adequate hydration Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 29 Suctioning    Maintains patent airway, promotes gas exchange Assess the need in patients who cannot cough adequately Done through nose or mouth Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 30 10 4/4/2015 Complications of Suctioning      Hypoxia Tissue (mucosal) trauma Infection Vagal stimulation, bronchospasm Cardiac dysrhythmias from induced hypoxia Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 31 Bronchial and Oral Hygiene    Turn/reposition every 1 to 2 hours, support out-of-bed activities, encourage early ambulation Coughing and deep breathing, chest percussion, vibration, and postural drainage promote pulmonary cure Avoid glycerin swabs or mouthwash containing alcohol for oral care; assess for ulcers, bacterial/fungal growth, infection Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 32 Nutrition with Tracheostomy    Swallowing can be a major problem for patients with tracheostomy tube If balloon is inflated, can interfere with passage of food through the esophagus Elevate head of bed for at least 30 min after eating to prevent aspiration during swallowing Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 33 11 4/4/2015 Weaning from a Tracheostomy Tube      Weaning—gradual decrease in tube size; ultimate removal of tube Cuff is deflated when patient can manage secretions; does not need assisted ventilation Change from cuffed to uncuffed tube Size of tube decreased by capping; use smaller fenestrated tube Tracheostomy button has potential danger of getting dislodged Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 34 A patient was admitted with a diagnosis of respiratory failure 3 weeks ago. She required an artificial airway (tracheostomy) to help clear her secretions. The previous shift nurse reports that the patient had a very restless night with a drop in her O2 saturation level several times despite her O2 being set at 40% via trach collar. The previous shift nurse also reports that the patient experienced tachycardia and tachypnea during the night. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 35 (Cont.) The nurse immediately checks on the patient and finds that she appears anxious and her vital signs are as follows:      Blood pressure: 128/84 mm Hg Heart rate: 114 (sinus tachycardia) Respiratory rate: 24 and labored Temperature: 99.4º F (axillary) O2 saturation: 91% on 40% O2 via trach collar Which of these findings are cause for concern? Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 36 12 4/4/2015 (Cont.) Based on the patient’s vital signs, what is the appropriate nursing action? A. Inform the provider of abnormal vital signs. B. Complete an assessment of airway and respiratory status. C. Provide patient teaching regarding relaxation techniques. D. Notify the Rapid Response Team for extra assistance. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 37 (Cont.) As the assessment is completed, the nurse observes that the patient has a large amount of thick secretions visible in the trach. What is the priority nursing action? A. Add pulmonary toileting to daily interventions. B. Instruct the UAP to sit with the patient until she is calmer. C. Call the respiratory therapist for a stat bronchodilator treatment. D. Suction the artificial airway and remove the secretions. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 38 (Cont.) After morning care, the student nurse is to perform tracheostomy care under the RN’s supervision. Which instructions does the RN give the student nurse? (Select all that apply.) A. B. C. D. E. Create a sterile field. Change trach ties if soiled. Remove old dressings and excess secretions. Suction the tracheostomy tube after the trach care. Clean the inner cannula with full-strength hydrogen peroxide. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 39 13 4/4/2015 Chapter 28 Audience Response System Questions Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 40 40 Question 1 True or False: Flammable solutions containing high concentrations of alcohol or oil should not be used in rooms with oxygen. Therefore, hand hygiene using alcohol-based foams or gels should be avoided when caring for patients on oxygen therapy. A. True B. False Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 41 Question 2 The nurse is caring for a patient with a cuffed tracheostomy and is aware the patient is at risk for developing which complication? A. B. C. D. Pneumothorax Tracheomalacia Subcutaneous emphysema Trachea–innominate artery fistula Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 42 14 4/4/2015 Question 3 While suctioning a patient, vagal stimulation occurs. What is the appropriate nursing action? A. B. C. D. Instruct the patient to cough. Place the patient in a high Fowler’s position. Oxygenate the patient with 100% oxygen. Instruct the patient to breathe slowly and deeply. Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 43 15 4/4/2015 Chapter 27 Assessment of the Respiratory System Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. Anatomy & Physiology Review      Upper respiratory tract Lower respiratory tract Lungs Accessory muscles of respiration Oxygen delivery and the oxygen-hemoglobin dissociation curve Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 2 Role of the Respiratory System Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 3 1 4/4/2015 Relevant Patient History        Family and personal data Smoking (pack-years) Drug use Allergies Travel, geographic area of residence Nutritional status Cough, sputum production, chest pain, dyspnea, PND, orthopnea Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 4 Assessment of the Nose & Sinuses       External nose – Deformities or tumors Nares – Symmetry of size and shape Nasal cavity – Color, swelling, drainage, bleeding Mucous membranes – Abnormalities Septal deviation Turbinates Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 5 Assessment of the Nose & Sinuses (Cont.) Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 6 2 4/4/2015 Assessment of the Pharynx, Trachea, & Larynx     Mouth Posterior pharynx Neck – Symmetry, alignment, masses, swelling, bruises, use of accessory neck muscles for breathing Trachea – Palpate for position, mobility, tenderness, masses Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 7 Assessment of the Pharynx, Trachea, & Larynx (Cont.) Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 8 Assessment of the Lungs & Thorax     Inspect thorax with patient sitting up Observe chest, compare one side with the other Work from the apex, move downward toward base (from side to side) Rate, rhythm, depth of inspiration as well as symmetry of chest movement Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 9 3 4/4/2015 Assessment of the Lungs & Thorax (Cont.)     Examine AP diameter with lateral diameter Distance between ribs (intercostal space) Palpate to assess respiratory movement, symmetry Crepitus Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 10 Assessment of the Lungs & Thorax (Cont.)   Diaphragmatic excursion Lung sounds     Bronchial Bronchovesicular Vesicular Adventitious sounds     Crackles Wheezes Rhonchi Pleural friction rub Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 11 Assessment of the Lungs & Thorax (Cont.) Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 12 4 4/4/2015 Other Indicators of Respiratory Adequacy       Clubbing of fingers Weight loss Unevenly developed muscles Skin and mucous membrane changes General appearance Activity tolerance Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 13 Psychosocial Assessment    Stress may worsen some respiratory problems Chronic respiratory disease may cause changes in family roles, social isolation, financial problems due to unemployment or disability Discuss coping mechanisms, offer access to support systems Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 14 Laboratory Tests      Blood Sputum Standard chest x-rays, digital chest radiography, CT Ventilation and perfusion scan Pulse oximetry (noninvasive) Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 15 5 4/4/2015 Pulmonary Function Testing   Noninvasive Evaluate lung volumes and capacities, flow rates, diffusion capacity, gas exchange, airway resistance, distribution of ventilation Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 16 Capnometry & Capnography    Noninvasive Measure amount of carbon dioxide present in exhaled air Normal pressure of PETCO2 is between 20 and 40 mm Hg Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 17 Other Noninvasive Testing   Exercise testing Skin testing Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 18 6 4/4/2015 Invasive Diagnostic Tests   Bronchoscopy Thoracentesis – Aspiration of pleural fluid or air from pleural space     Stinging sensation and feeling of pressure Correct position Motionless patient Follow-up assessment for complications Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 19 Lung Biopsy     Invasive Obtain tissue for histologic analysis, culture, cytologic examination May be performed in patient’s room Follow-up care:     Assess vital signs, breath sounds at least every 4 hours for 24 hours Assess for respiratory distress Report reduced/absent breath sounds immediately Monitor for hemoptysis Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 20 Chapter 27 Audience Response System Questions Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 21 21 7 4/4/2015 Question 1 The nurse understands that the expected assessment for the older adult related to the natural aging process of the respiratory system includes which finding? A. B. C. D. Tightening of the vocal cords Decrease in residual volume Decrease in the anteroposterior diameter Decrease in respiratory muscle strength Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 22 Question 2 The nurse knows that under normal physiologic conditions of tissue perfusion, a patient will have what percent of oxygen dissociate from the hemoglobin molecule? A. B. C. D. 25% 50% 75% 100% Copyright © 2016, 2013, 2010, 2006, 2002 by Saunders, an imprint of Elsevier Inc. 23 Question 3 The nurse understands which symptom to be a hallmark subjective sign of lung disease? A. B. C. D. Cough Dyspne ...
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